会谈中的当事人阻抗及工作同盟的影响因素:一项过程研究

从心理咨询过程研究视角,以38个会谈为对象,考察咨询师指导和当事人特质逆反对当事人阻抗的影响,并检验三者对工作同盟的影响。结果:指导正向预测阻抗,特质逆反则不能,二者的交互作用也不显著;阻抗负向预测工作同盟,指导则不能,二者的交互作用和中介作用都不显著,但阻抗的中介效应相对更大。结论:咨询师指导增加当事人阻抗;当事人阻抗破坏工作同盟,并在咨询师指导对工作同盟的影响过程中可能起中介作用。     

心理咨询中的突然获益：工作同盟及初始症状的影响

对82位当事人在咨询中的症状改变过程进行纵向研究,检验突然获益模式（Sudden Gain, SG）的发生及其与咨询效果的联系,并探索初始症状水平、工作同盟对SG的影响。结果表明,24.93%的当事人经历了SG,咨询效果显著好于其他当事人;SG组与对照组在初始症状水平和总体工作同盟水平上差异显著。结论：SG出现于本土心理咨询中,经历SG的当事人取得了更好的咨询效果,工作同盟与初始症状水平与SG的发生相关。     

阅读进度反馈信息对工作同盟和咨询效果的影响

进度反馈指将对当事人的标准化测量结果和解释反馈给咨询师的干预, 其目的在于矫正咨询师对咨询效果主观评估的偏差, 提高咨询效果。考虑到咨询师和当事人“面对面”的标准反馈程序不符合我国社会文化习惯, 采用多层结构方程模型, 分析了自然情境下非“面对面”的进度反馈对工作同盟和咨询效果的影响。结果发现, 在组间水平, 反馈组的工作同盟质量更好; 在组内水平, 工作同盟与症状是相互预测的关系。在结案时, 反馈组在抑郁症状和咨询的有帮助性上效果更好。结论是进度反馈对工作同盟和咨询效果有积极影响。研究从工作同盟和中国人的关系角度拓展了对进度反馈作用机制的认识, 为进度反馈的应用提供了基于实践干预有效的证据。     

工作同盟的结构：基于两种测量工具的检验

以大学心理咨询中心的当事人为样本,对国外两种广泛使用的工作同盟测量工具WAI-S和WAI-SR的结构和测量学指标进行检验。结果发现,WAI-S和WAI-SR的任务一致与目标一致两个维度的相关较高,分别为0.71和0.74;WAI-S和WAI-SR的一因素、二因素和三因素结构均没有得到充分支持;WAI-SR与咨询效果的相关不显著。WAI-S和WAI-SR的结构不能很好反映其所依据的理论假设,提示在对测量工具进行改进的同时,还需要对工作同盟的理论结构进行思考。     

心理咨询中工作同盟的发展模式与咨询效果

为了探索工作同盟在咨询过程中的发展模式, 采用Stiles等(2004)提出的4个变化特征参数(shape-of-change parameters)对30个个案的工作同盟在咨询过程中的发展变化进行描述。聚类分析的结果显示有3类工作同盟的发展模式, 分别是线性增长、线性下降和二次增长模式。不过, 3种发展模式、4个变化特征参数及同盟的破裂?修复片段对咨询效果均没有影响。比较咨询效果不同的当事人在工作同盟发展模式上的差异, 发现同一个发展模式对于不同的个案可能有着不同的含义, 咨询师在早期对同盟关系的处理与调控对咨询效果有着重要的影响。     

工作同盟和领悟对咨询效果的影响

为了解短程咨询中工作同盟和领悟对咨询效果的影响,以12个个案94次会谈为对象,考察工作同盟、领悟分别与会谈效果、治疗效果的关系,并考察二者共同作用于效果的方式。结果表明,咨访双方评定的工作同盟都可以正向预测会谈效果,但不能预测治疗效果;领悟与会谈有效性正相关,领悟正向预测治疗效果;咨询师评定的同盟的三个维度以领悟为中介影响其对会谈效果的评价。     

当事人眼中的团体辅导效果：基于协商一致的质性研究

目的：本文从当事人的视角,深入研究团体辅导对于团体成员所产生的作用。方法：采用协商一致的质性研究（CQR）方法,对15个来自不同团体的当事人的深度访谈材料进行分析。结果：发现与团体辅导效果相关的域有4个,即团体辅导的过程效果、团体辅导效果获得的过程和体验、团体辅导效果的影响因素,团体辅导的后续效果。结论：当事人眼里团体辅导效果的内容广泛且丰富,团体依恋既是团体辅导效果的内容也是基础性的疗效因子。     

心理咨询过程-效果研究现状及展望

心理咨询过程-效果研究考察咨询过程变量对咨询效果的影响。以人为中心流派、认知流派、行为流派、精神分析流派等都为该研究领域提供了理论基础。主要研究内容有咨询师的反应方式、会谈中的当事人行为、工作同盟、会谈中的重要内容等过程变量与效果的关系。该领域积累的成果还不多,这可能与过程-效果关系本身的复杂性有关,同时研究方法尚有许多欠缺,如考察复杂关系时使用的研究设计过于简单、测量工具不统一导致结果难以比较,有些测量工具不成熟信效度不高。未来的研究除了努力克服这些问题外,还应多考虑理论构建、内隐变量的调节和中介作用、当事人变量,在研究方法上应更为综合和多样化     

心理咨询中当事人的改变过程：同化模型的视角

摘 要 目的：选用心理咨询中获得成功改变的中国当事人,验证美国学者William B. Stiles等提出的同化模型。方法：采用同化分析这一用来追踪心理治疗中当事人问题经验发展进程的研究方法,对案例的会谈逐字稿资料进行分析。结果：三位研究者追踪到了两个主题（两对声音）,摘录了68个段落。其对两个主题摘录段落的同化评分与三位独立评定者的评分具有较高的相关（0.90和0.85）,同化的评分随着会谈的进程而提高（相关分别为0.89和0.91）。当事人在心理咨询中的改变过程遵循同化模型有关治疗改变的发展序列。结论：中国当事人的心理咨询改变过程支持同化模型的理论构想。     

当事人的投入:概念、测量与影响因素

当事人的投入是其从心理咨询与治疗中获益的基本前提,它是指当事人为了实现改变的目标,在咨询或治疗过程中主动参与、不懈努力的心理和行为过程。目前对投入的研究主要考察了行为表现,包括出席会谈、会谈中的投入和会谈外的投入三个核心成分,对应有不同的测量方法。与投入有关的因素包括当事人因素、咨询师及互动因素、家庭和社会文化因素、其他客观因素等,其中当事人的认知动机因素对投入有重要影响。未来研究应继续探讨当事人投入的成分、动力性和影响因素,完善其评估方法及增强当事人投入的干预方法,并进一步检验当事人的投入与咨询效果的关系。     

Comparing Alliance in Two Cognitive-Behavioural Therapies for Adolescents With ADHD Using a Randomized Controlled Trial

Alliance is defined as the client-therapist bond and their ability to collaborate on therapeutic activities. Treatment for adolescents with ADHD is rarely studied in terms of alliance. In this study, two cognitive-behavioral treatments (CBT; one structured treatment aimed at planning skills and one less-structured solution-focused treatment, both delivered in the style of Motivational Interviewing) were compared with regard to alliance and alliance-outcome association. The influence of therapist competence on this alliance-outcome association was also evaluated. The alliance between 69 adolescents diagnosed with ADHD and their therapists was measured early in treatment, using the Therapy Process Observational Coding System for Child Psychotherapy–Alliance scale. Observer-rated therapist competence was measured using the Motivational Interviewing Treatment Integrity scale (version 3.1.1.). Outcome variables were the adolescents’ reduction in planning problems and ADHD symptoms. The alliance, and, more specifically, collaboration on therapeutic activities, was significantly higher for the more structured CBT (p = .04; moderate effect size). Alliance was not related to outcome in the more structured CBT, while the alliance was positively related to the reduction in planning problems in the less structured CBT. Finally, alliance was a significant mediator between therapist competence and treatment outcome for the less-structured CBT. The clarity and structure of CBT may help facilitate alliance formation for adolescents with ADHD who often have difficulty implementing structure themselves. Therapists may need to invest more in alliance formation in less structured CBT as the alliance affects outcome. Moreover, enhancing therapist competence in less structured CBT may help improve outcomes in less structured CBT, as therapist competence may impact outcome through alliance.     

Der ausreichend gute Therapeut

Psychotherapists show a great variation in their ability to achieve positive outcomes in therapy. Specifically, they vary in terms of their ability to identify and repair ruptures in the therapeutic alliance. Alliance ruptures are a frequent phenomenon but often go undetected; however, repairing alliance ruptures represents a great opportunity to improve the psychotherapy process and therapy outcome. Empirical research suggests that patient feedback should be included in the psychotherapy process to be able to detect alliance ruptures better. From a psychodynamic point of view, a “sufficiently good” therapist is a therapist who can acknowledge the countertransference-based limitations in evaluating the therapeutic alliance with patients and the need to use feedback in order to detect and repair inevitable alliance ruptures. The consequences for research, practice and psychotherapy training are considered.     

Developing the therapeutic alliance in acute mental health care

The establishment of a good working relationship, or therapeutic alliance, is seen as a key indicator of good outcome in all forms of psychological therapy. Such a relationship, however, is difficult to establish in acute mental health, when the patient may both need and fear therapeutic contact. The patient care plan can give the appearance of a positive working alliance when this is not truly established. The Care Plan Approach can prioritize case management and risk assessment over treatment. A good therapeutic alliance can often be achieved in times of acute crisis, but only when the difficulties in so doing are recognized and acknowledged. The distinction between benign and malign dependency can be a useful way of conceptualizing therapeutic and non‐therapeutic factors in acute care. Apparently progressive paradigms in mental health care serve to deny the inherent difficulties and conflicts involved in establishing a therapeutic alliance in cases of severe mental illness. Developing a genuine therapeutic culture in acute mental health requires that organizational structures and protocols are clinically informed and are congruent with the therapeutic ethos desired. Examples from a recently established Acute Day Hospital will illustrate how a psychodynamically‐informed group‐based treatment can be effective in developing the therapeutic alliance. I will focus on Psychiatric Nursing, although I hope that the content of the paper is more widely applicable.     

Governance Processes and Change Within Organizational Participants of Multi-sectoral Community Health Care Alliances: The Mediating Role of Vision,Mission, Strategy Agreement and Perceived Alliance Value

Multi-sectoral community health care alliances are organizations that bring together individuals and organizations from different industry sectors to work collaboratively on improving the health and health care in local communities. Long-term success and sustainability of alliances are dependent on their ability to galvanize participants to take action within their ‘home’ organizations and institutionalize the vision, goals, and programs within participating organizations and the broader community. The purpose of this study was to investigate two mechanisms by which alliance leadership and management processes may promote such changes within organizations participating in alliances. The findings of the study suggest that, despite modest levels of change undertaken by participating organizations, more positive perceptions of alliance leadership, decision making, and conflict management were associated with a greater likelihood of participating organizations making changes as a result of their participation in the alliance, in part by promoting greater vision, mission, and strategy agreement and higher levels of perceived value. Leadership processes had a stronger relationship with change within participating organizations than decision-making style and conflict management processes. Open-ended responses by participants indicated that participating organizations most often incorporated new measures or goals into their existing portfolio of strategic plans and activities in response to alliance participation.     

Research Developments on the Therapeutic Alliance in Psychodynamic Psychotherapy

Research on psychotherapy in general, and psychodynamic therapy in particular, has consistently found that the quality of the alliance predicts the outcome of treatment. Little empirical support exists for the notion that the alliance sets the stage for techniques to be most effective, although adequate studies of this interaction between techniques and alliance are scarce. Research suggests that that the alliance is influenced in part by preexisting patient characteristics and in part by the quality of therapist interventions. Limitations of the empirical literature on the alliance are presented and some suggestions for future research are given.     

召陵之盟及其历史意义

“召陵之盟”是先秦史上的大事件，尤其是春秋时期齐、楚关系史上的大事件。它是管仲和齐桓公精心谋划且费尽心机的成功会盟，反映了管仲和齐桓公的政治气度、远见、才能和成就，具有巨大而深远的历史意义。它确立了当时齐国的天下霸主地位，实现了楚人“观中国之政”的宿愿，避免了一场社会大战乱，还树立了天下霸主的典范，从而使得中国南北政治、经济和文化在春秋时期日益密切地联系在一起，并且因对春秋霸主及争霸的诸侯有着示范作用而影响了春秋历史的发展。     

Using client feedback in training of future counseling psychologists: An evidence-based and social justice practice

Training in counseling psychology has evolved to emphasize both evidence-based practice (EBP) and social justice, though these two dimensions have often seemed disconnected, or even at odds in the practice of psychotherapy. The Partners for Change Outcome Management System (PCOMS), an EBP that monitors treatment outcomes and the therapeutic alliance across treatment (often called “client feedback”), may offer a means to connect evidence-based and socially just practices. The purpose of this article was to outline how the use of PCOMS in psychotherapy and supervision can serve as a useful training tool that is a form of EBP and also promotes a socially just paradigm in psychotherapy. We also offer an implementation example from a counseling psychology doctoral program to demonstrate how PCOMS can be used with clients in psychotherapy and included within the supervisory process.     

The Supervisory Alliance as Quintessential Integrative Variable

The concept of alliance in psychotherapy supervision is now a half century old. But over the course of its first 50 years, how has the supervisory alliance come to generally be viewed by supervision scholars and practitioners? and What is its specific place now within different visions of supervision? In this paper, I would like to consider those two questions by: (a) describing the two enduring perspectives on the supervisory alliance that have dominated and continue to dominate the supervisory scene; and (b) examining the ways in which the alliance appears to currently be conceptualized and implemented across several distinct views of supervision. Each view of supervision is also presented as containing and actuating its own message and meaning about the role of alliance in supervision, and those messages and meanings are accordingly identified. The supervisory alliance appears to now be widely regarded as being a transtheoretical common factor that binds by means of: (a) bond/rapport; (b) supervision goals; and (c) supervision tasks. Much like the therapeutic alliance in psychotherapy, the supervisory alliance has increasingly come to be seen as the very heart and soul of supervision itself and may indeed be the quintessential integrative variable in psychotherapy supervision.     

Alliance-Outcome Associations in a Community-Based Social Skills Intervention for Youth With Autism Spectrum Disorder

Although the alliance is a consistent predictor of treatment outcomes in psychosocial interventions, few studies have examined this association among youth with autism spectrum disorder (ASD). In particular, youth-therapist alliance has never been examined in social skills interventions (SSIs), a common modality for this population. In this study, thirty-four youth with ASD (M_age = 12.41; 79% male) participated in a community-delivered, group-based SSI in a summer camp format led by eight Head Therapists (M_age = 32.12; 50% male). Early alliance and change in alliance over the course of the treatment were assessed via self- and observer-reported measures. Both self- and observer-rated alliance were associated with positive treatment outcomes as reported by parents (decreased problem behaviors) and other peers in the group (reciprocated friendship and social preference). These results provide the first evidence of the role of the alliance in an SSI for youth with ASD and add to the growing body of literature that demonstrates the importance of assessing and addressing the alliance in treatment for this population.